子宫内膜癌淋巴转移的危险因素分析

Analysis of the risk factors of endometrial cancer with lymph node metastases

目的子宫内膜癌可通过淋巴转移、直接蔓延、血行转移途径转移,其中淋巴转移为主要途径。早期子宫内膜癌初始治疗时术中是否行淋巴结切除仍存在争议。本研究拟通过回顾性分析子宫内膜癌盆、腹腔淋巴结转移的危险因素,为术中是否行淋巴结切除提供依据。方法对2008-01-01-2015-05-01在中国医科大学附属盛京医院住院的818例子宫内膜癌患者的临床资料进行回顾性分析。选取年龄、病理类型、分化程度、肌层浸润深度、CA125水平等可能与发生淋巴转移的相关危险因素,并通过SPSS 17.0软件和Logistic回归模型进行统计分析。结果 818例子宫内膜癌患者中淋巴结转移88例(10.76%),其中盆腔淋巴结转移85例(10.39%),腹主动脉旁淋巴结转移15例(8.72%)。单因素分析结果显示子宫内膜癌淋巴结转移与肿瘤部位、分化程度、病理类型、肌层浸润深度、宫颈浸润、附件转移、宫旁转移、CA125、雌激素受体、孕激素受体、盆腔部位转移、合并子宫肌瘤相关,P值均<0.05。多因素分析结果显示,分化程度、病理类型、肌层浸润、附件转移、CA125水平升高是子宫内膜癌淋巴结转移的独立危险因素,P值均<0.05。结论子宫内膜癌术中应充分考虑分化程度、病理类型、肌层浸润、附件转移、CA125水平等危险因素,以决定是否行淋巴切除术。

OBJECTIVE Endometrial carcinoma spreads through lymphatic metastasis, direct, invasion,hematogenous metastasis. Lymphatic metastasis is the main way of transfer. For the early endometrial carcinoma intimal surgery treatment,there is still a dispute about performing the resection of lymph node simultaneously. This study aims to provide basis for endometrial carcinoma surgery treatment with the resection of lymph node simultaneously by retrospective analysis of risk factors of endometrial carcinoma pelvic peritoneal lymph node metastasis. METHODS We retrospectively analyzed the clinical data from 818 patients who hospitalized at China Medical University Affiliated Shengjing Hospital from January 1st 2008 to May 1st 2015. We chose the lymph node metastasis relative risk factors such as ages, pathological types, differentiation degree, depth of myometrial invasion and the level of CA125 to do correlation analysis by SPSS 17.0 and Logistic regression model. RESULTS There were 88 patients（10.76%） occurred lymph node metastasis,including 85 patients with pelvic lymph node metastasis and 15 patients with para-aortic lymph node metastasis,the metastatic rate was respectively 10.39 % and 8.72 %. Single factor analysis results showed endometrial carcinoma lymph node metastasis was related with tumor sites, pathological types,differentiation degree, depth of myometrial invasion, cervical invasion, accessory metastasis, parametrium metastasis, CA125, estrogen receptor, progesterone receptor, pelvic metastasis, com- plicated with uterine leiomyoma（all P〈0.05）. Multiple factors analysis results showed there were independent risk factors including differentiation degree, pathological types, myometrial invasion, accessory metastasis, the level of CA125 in crease（all P〈0.05）for the metastasis of endometrial carcinoma. CONCLUSIONS In endometrial carcinoma before surgery treatment, whether to performe the resection of lymph node simultaneously or not is depend on risk factors including the differentiation degree,pathological types, myometrial invasion, accessory metastasis and the level of CA125.